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Overview of Prescription Opioid Deaths in the Oklahoma State Medicaid Population, 2012-2016.
Med Care. 2018 08; 56(8):727-735.MC

Abstract

BACKGROUND

Medicaid members are predisposed to unintentional prescription opioid overdose. However, little is known about their individual risk factors.

OBJECTIVES

To describe demographic and clinical characteristics, medical utilization, opioid use, concurrent use of benzodiazepines, risk factors, and substances involved in death for Oklahoma's Medicaid members who died of unintentional prescription opioid poisoning.

SUBJECTS

Decedents who were Medicaid eligible in Oklahoma during the year of death, had an opioid recorded in cause of death, and had ≥1 opioid prescription claim between January 1, 2011 and June 30, 2016 were cases. Controls were living Medicaid members and were matched 3:1 to cases through propensity score matching.

MEASURES

Demographics, clinical characteristics, and medical/pharmacy utilization were examined in the 12 months before the index date.

RESULTS

Of 639 members with fatal unintentional prescription opioid overdoses, 321 had ≥1 opioid prescription claim in the year before death; these were matched to 963 controls. Compared with controls, decedents had significantly greater proportions of nonopioid substance use disorders, opioid abuse/dependence, hepatitis, gastrointestinal bleeding, trauma not involving motor vehicle accidents, nonopioid poisonings, and mental illness disorders. Decedents had significantly higher daily morphine milligram equivalent doses (67.2±74.4 vs. 47.2±50.9 mg) and greater opioid/benzodiazepine overlap (70.4% vs. 35.9%). Benzodiazepines were involved in 29.3% of deaths.

CONCLUSIONS

Several comorbidities indicative of opioid use disorder and greater exposure to opioids and concomitant benzodiazepines were associated with unintentional prescription opioid overdose fatalities. Prescribers and state agencies should be aware of these addressable patient-level factors among the Medicaid population. Targeting these factors with appropriate policy interventions and education may prevent future deaths.

Authors+Show Affiliations

Department of Pharmacy, Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, OK.Department of Pharmacy, Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, OK.Purdue Pharma L.P., Stamford, CT.Purdue Pharma L.P., Stamford, CT.Department of Pharmacy, Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, OK.Department of Pharmacy, Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, OK.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29995696

Citation

Pham, Timothy T., et al. "Overview of Prescription Opioid Deaths in the Oklahoma State Medicaid Population, 2012-2016." Medical Care, vol. 56, no. 8, 2018, pp. 727-735.
Pham TT, Skrepnek GH, Bond C, et al. Overview of Prescription Opioid Deaths in the Oklahoma State Medicaid Population, 2012-2016. Med Care. 2018;56(8):727-735.
Pham, T. T., Skrepnek, G. H., Bond, C., Alfieri, T., Cothran, T. J., & Keast, S. L. (2018). Overview of Prescription Opioid Deaths in the Oklahoma State Medicaid Population, 2012-2016. Medical Care, 56(8), 727-735. https://doi.org/10.1097/MLR.0000000000000944
Pham TT, et al. Overview of Prescription Opioid Deaths in the Oklahoma State Medicaid Population, 2012-2016. Med Care. 2018;56(8):727-735. PubMed PMID: 29995696.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Overview of Prescription Opioid Deaths in the Oklahoma State Medicaid Population, 2012-2016. AU - Pham,Timothy T, AU - Skrepnek,Grant H, AU - Bond,Christopher, AU - Alfieri,Thomas, AU - Cothran,Terry J, AU - Keast,Shellie L, PY - 2018/7/12/entrez PY - 2018/7/12/pubmed PY - 2019/3/13/medline SP - 727 EP - 735 JF - Medical care JO - Med Care VL - 56 IS - 8 N2 - BACKGROUND: Medicaid members are predisposed to unintentional prescription opioid overdose. However, little is known about their individual risk factors. OBJECTIVES: To describe demographic and clinical characteristics, medical utilization, opioid use, concurrent use of benzodiazepines, risk factors, and substances involved in death for Oklahoma's Medicaid members who died of unintentional prescription opioid poisoning. SUBJECTS: Decedents who were Medicaid eligible in Oklahoma during the year of death, had an opioid recorded in cause of death, and had ≥1 opioid prescription claim between January 1, 2011 and June 30, 2016 were cases. Controls were living Medicaid members and were matched 3:1 to cases through propensity score matching. MEASURES: Demographics, clinical characteristics, and medical/pharmacy utilization were examined in the 12 months before the index date. RESULTS: Of 639 members with fatal unintentional prescription opioid overdoses, 321 had ≥1 opioid prescription claim in the year before death; these were matched to 963 controls. Compared with controls, decedents had significantly greater proportions of nonopioid substance use disorders, opioid abuse/dependence, hepatitis, gastrointestinal bleeding, trauma not involving motor vehicle accidents, nonopioid poisonings, and mental illness disorders. Decedents had significantly higher daily morphine milligram equivalent doses (67.2±74.4 vs. 47.2±50.9 mg) and greater opioid/benzodiazepine overlap (70.4% vs. 35.9%). Benzodiazepines were involved in 29.3% of deaths. CONCLUSIONS: Several comorbidities indicative of opioid use disorder and greater exposure to opioids and concomitant benzodiazepines were associated with unintentional prescription opioid overdose fatalities. Prescribers and state agencies should be aware of these addressable patient-level factors among the Medicaid population. Targeting these factors with appropriate policy interventions and education may prevent future deaths. SN - 1537-1948 UR - https://www.unboundmedicine.com/medline/citation/29995696/Overview_of_Prescription_Opioid_Deaths_in_the_Oklahoma_State_Medicaid_Population_2012_2016_ L2 - https://doi.org/10.1097/MLR.0000000000000944 DB - PRIME DP - Unbound Medicine ER -